Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

V L Negenborn, R E G Dikmans, M B Bouman, H A H Winters, J W R Twisk, P Q Ruhé, M A M Mureau, J M Smit, S Tuinder, J Hommes, Y Eltahir, N A S Posch, J M van Steveninck-Barends, M A Meesters-Caberg, R R W J van der Hulst, M J P F Ritt, M G Mullender

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction.

METHODS: Data were obtained from the BRIOS study, including all patients treated with DTI ADM-assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications.

RESULTS: Fifty-nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance.

CONCLUSION: Breast size appeared to be the most significant predictor of complications in DTI ADM-assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).

Original languageEnglish
Pages (from-to)1305-1312
Number of pages8
JournalBritish Journal of Surgery
Volume105
Issue number10
Early online date16 Apr 2018
DOIs
Publication statusPublished - 1 Sep 2018

Cite this

Negenborn, V L ; Dikmans, R E G ; Bouman, M B ; Winters, H A H ; Twisk, J W R ; Ruhé, P Q ; Mureau, M A M ; Smit, J M ; Tuinder, S ; Hommes, J ; Eltahir, Y ; Posch, N A S ; van Steveninck-Barends, J M ; Meesters-Caberg, M A ; van der Hulst, R R W J ; Ritt, M J P F ; Mullender, M G. / Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial. In: British Journal of Surgery. 2018 ; Vol. 105, No. 10. pp. 1305-1312.
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title = "Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial",
abstract = "BACKGROUND: In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction.METHODS: Data were obtained from the BRIOS study, including all patients treated with DTI ADM-assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications.RESULTS: Fifty-nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance.CONCLUSION: Breast size appeared to be the most significant predictor of complications in DTI ADM-assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).",
author = "Negenborn, {V L} and Dikmans, {R E G} and Bouman, {M B} and Winters, {H A H} and Twisk, {J W R} and Ruh{\'e}, {P Q} and Mureau, {M A M} and Smit, {J M} and S Tuinder and J Hommes and Y Eltahir and Posch, {N A S} and {van Steveninck-Barends}, {J M} and Meesters-Caberg, {M A} and {van der Hulst}, {R R W J} and Ritt, {M J P F} and Mullender, {M G}",
note = "{\circledC} 2018 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.",
year = "2018",
month = "9",
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doi = "10.1002/bjs.10865",
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Negenborn, VL, Dikmans, REG, Bouman, MB, Winters, HAH, Twisk, JWR, Ruhé, PQ, Mureau, MAM, Smit, JM, Tuinder, S, Hommes, J, Eltahir, Y, Posch, NAS, van Steveninck-Barends, JM, Meesters-Caberg, MA, van der Hulst, RRWJ, Ritt, MJPF & Mullender, MG 2018, 'Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial' British Journal of Surgery, vol. 105, no. 10, pp. 1305-1312. https://doi.org/10.1002/bjs.10865

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial. / Negenborn, V L; Dikmans, R E G; Bouman, M B; Winters, H A H; Twisk, J W R; Ruhé, P Q; Mureau, M A M; Smit, J M; Tuinder, S; Hommes, J; Eltahir, Y; Posch, N A S; van Steveninck-Barends, J M; Meesters-Caberg, M A; van der Hulst, R R W J; Ritt, M J P F; Mullender, M G.

In: British Journal of Surgery, Vol. 105, No. 10, 01.09.2018, p. 1305-1312.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial

AU - Negenborn, V L

AU - Dikmans, R E G

AU - Bouman, M B

AU - Winters, H A H

AU - Twisk, J W R

AU - Ruhé, P Q

AU - Mureau, M A M

AU - Smit, J M

AU - Tuinder, S

AU - Hommes, J

AU - Eltahir, Y

AU - Posch, N A S

AU - van Steveninck-Barends, J M

AU - Meesters-Caberg, M A

AU - van der Hulst, R R W J

AU - Ritt, M J P F

AU - Mullender, M G

N1 - © 2018 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - BACKGROUND: In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction.METHODS: Data were obtained from the BRIOS study, including all patients treated with DTI ADM-assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications.RESULTS: Fifty-nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance.CONCLUSION: Breast size appeared to be the most significant predictor of complications in DTI ADM-assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).

AB - BACKGROUND: In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction.METHODS: Data were obtained from the BRIOS study, including all patients treated with DTI ADM-assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications.RESULTS: Fifty-nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance.CONCLUSION: Breast size appeared to be the most significant predictor of complications in DTI ADM-assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).

U2 - 10.1002/bjs.10865

DO - 10.1002/bjs.10865

M3 - Article

VL - 105

SP - 1305

EP - 1312

JO - British Journal of Surgery

JF - British Journal of Surgery

SN - 0007-1323

IS - 10

ER -